There is a common perception that burned children are at risk for growth deceleration. However, because the prevalence, duration, and degree of this stereotypic growth are poorly described, making informed decisions about treatment is difficult. This article describes the natural history of growth after burn injury, according to the findings of a retrospective review conducted in a regional pediatric burn center. The study population comprised children younger than 13 years at the time of injury, who survived burns involving >or=30% TBSA. Main outcome measures were height and weight; values obtained upon admission for burn injury and at all subsequent hospital admissions were converted to height-for-age and weight-for-age Z scores with use of a reference standard. Z scores were then used to determine whether baseline height and weight status (according to initial admission data) were recouped after burn injury. Medical records of 159 patients (2910 admissions) were reviewed. Children with massive burns (>or=50% TBSA) had height-for-age Z scores that were significantly below their baseline average for all years studied (mean fall in Z score units of 0.50-0.76; P < .0001). This decline in height-for-age Z scores represented a deficit of 1.6 to 5.8 cm. Seventeen patients (11%) had height-for-age Z scores consistent with stunting. Weight-for-age Z scores were not statistically lower than the reference standard, except for patients with massive burns up to 1.5 years post-burn. In our population of burned children, only massively burned children demonstrated a decline in stature. The decline for most was modest.